Student: Sam Jones

Age: 11
Student characteristics:

Sam is a rising fifth grader with an infectious laugh and a positive attitude. She is a
friendly and motivated member of her class. She has been receiving special education
services throughout her time in school in several content areas, having been determined
eligibile at age 2 1/2. Many of Sam's struggles stem from her diagnosis of Down's Syndrome.
She enjoys reading to learn about new things and swimming afterschool. Sam reads
independently at a level J, using the Teacher's College independent reading level
assessments. She recently participated in the Special Olympics, an event that brought her a
great deal of pride and joy, which she communicated with her class both verbally and in
writing. She wears glasses to support her vision. She enjoys group work and is especially
passionate about science. Her teachers describe her as "a kind and helpful citizen in [their]
classroom community." She is eager to engage and participate with students of her age
group inside and out of the classroom.

Difficulties and Concerns:
Sam has struggled across content areas. She performs in the first percentile for her
age group in both reading in math on a consistent yearly basis. In math, she struggles with
addition and subtraction, specifically with subtracting numbers greater than two from
numbers 1-10. She also struggles to respond accurately when the problems are mixed, i.e.
when the addition and subtraction problems are assorted on the same page.
Sam also struggles to retain skills that she has practiced for a length of time. In
writing, handwriting is a consistent struggle that slows her down. In describing nouns, Sam
commonly uses descriptors of shape, size, and color, but does not go further. In the
classroom, Sam struggles to do some tasks in a timely manner. She sometimes becomes
confused during transitions and her motor skills limit her from being able to locate the
appropriate page in a textbook.
Sam has some social and behavioral difficulties. She is unable to read some social
cues, and will often use physical contact to communicate that she is pleased with the
company of a friend, but is unable to recognize that she is making her peer uncomfortable.
Often, Sam will elect to stay at her desk rather than come to the carpet when asked.

Prior Interventions:
No prior interventions are listed in Sams IEP. Based on the resources provided to her at ESY
and comments Sam has made, her Special Education teacher has used a scripted curriculum
in reading and math.


Student Name: Sam Johanson Resident Name: Sabrina Adikes
Home, Language, Cultural, and Other Considerations:
Sam's home language is English, and linguistic and cultural barriers have not been an issue
for her in the past. Her diagnosis of Downs Syndrome is relevant to considerations regarding
goals and interventions.
Sam is highly social and motivated by opportunities to contribute to groups small and large.

Student Accommodations and Modifications:
Sam has received a number of accommodations in order to alleviate the struggle she
experiences with handwriting, including the frequent use of 3-lined paper. During
assessments or independent work time, Sam has benefitted from extra time as well as the
occasional use of a scribe/dictation structure. She is also able to type faster than she can
write. In the Gen Ed classroom, Sam receives a great deal of staff support in the form of
verbal prompting in order to complete tasks and respond to assignments. Occasionally, the
use of a checklist or a copy of the day's schedule has supported Sam to be on task and
transition successfully.


Goals: (What outcomes do we want for the student? List 5. Be specific.)
Math: By 04/10/2015, when given a set of single digit mixed addition and subtraction
problems Sam will write the correct answers improving mixed single digit addition and
subtraction skills from 30% to 90% accuracy as measured by curriculum based assessment
Math: By 04/10/2015, when given a set of mixed coins Sam will add 2 types of coins
improving money skills from 10% accuracy to 80% accuracy adding 2 types of coins with 1
staff prompt as measured by curriculum based measurement.
Reading: By 04/10/2015, when given a reading passage at the lower 3rd grade level Sam will
read the passage improving reading fluency at the lower 3rd grade level from 50% accuracy
to 96% accuracy as measured by Brigance, TC assessment, or standardized test.
Reading: By 04/10/2015, when given a short story to read at the lower 3rd grade level
(LEVEL M) Sam will answer questions correctly improving comprehension from 0% to 75% at
level M, or beginning 3rd grade level as measured by Teachers College Assessment or
standardized test.
Writing: By 04/10/2015, when given an assignment to write a paragraph on a topic Sam
knows about Sam will use a graphic organizer to plan all components of her paragraph
improving writing planning from continuous prompts to no more than 3 prompts per
assignment as measured by student portfolio and teacher notes.

Intervention Plan:
1. Instructional Interventions
1. Math: Sam will use drawings and/or a number line to model
addition and subtraction. She will also comlete drills identifying
addition vs. subtraction problems.
2. Math: Sam will practice counting by 25s, as well as counting
by 10 starting at various multiples of 5 and 10 in order to build
her fluency in counting coins.
3. Reading: Sam will read aloud to a teacher attending
exclusively to fluency for 15 minutes 3 times per week.
4. Reading: Sam will read aloud to a teacher 2 times per week,
attending exclusively to comprehension and making
predictions and inferences about the text.
5. Writing: Sam will use completed graphic organizers to draft 5-
sentence paragraphs for 30 minutes 2 times per week.
2. Behavioral/Social Interventions
1. Sam will use verbal/non-physical communication to express
her appreciation of her peers.

Assessing the Effectiveness of the Interventions:
1. Reading: TC assessment
2. Writing: use of MSP rubric to evaluate writing
3. Math: CBA in addition/subtraction, regular assessment of counting
accuracy.





Student Name: Sam Johanson Resident Name: Sabrina Adikes
Intervention
Who is
Responsible
When Where Resources Needed
How Data
will be
Collected
Reading
Fluency
Special
Education
teacher
During
reading block
Resource
room
Texts at TC level M
Running
Record,
anecdotal
notes
Reading
Comprehension
Special
Education
teacher
During
reading block
Resource
room
Texts at TC level M,
list of
comprehension
questions
Anecdotal
notes
Math
addition/
subtraction
General
Education
teacher
During
morning
routine
Gen Ed
classroom
Worksheets with
addition and
subtraction
problems
Collection of
worksheets
Math counting
coins
Special
Education IA
During math
Resource
room
Assorted coins,
dry erase
board/marker
IA notes
Social
Special
Education IA
During
lunch/recess
Cafeteria,
playground
N/A
Anecdotal
notes














Student Interview
Student Name: Sam
Location (Phone, Email, In-person): In person
Date and Time of Interview: 7/15/14
What do you feel are your greatest strengths in school? Science, reading,
and art. I like to draw.
Are there any areas you feel you struggle with in school? Any particular
subjects? Math is hard, sometimes I get frustrated. Telling time is really
tricky.
What is your favorite subject? Art is my favorite because you get to talk
and I like making art.
What are ways that teachers have helped you be successful in school? Ms.
Lowe always lets me take my time. My teachers also let me have a schedule
on my desk, which I like.
Are there any other ways that you feel teachers could help you be
successful in school? I like working with my friends. Sometimes I dont like
working by myself.
Do you have any particular goals that you hope to reach during this school
year? I want to get better in reading and I want to learn how to count
coins.

Parent Interview
Student Name:
Parent Name(s):
Location (Phone, Email, In-person):
Date and Time of Interview:
What do you feel are your childs greatest strengths in school?
Are there any areas you feel you child struggles with in school? Any
particular subjects? During certain types of activities?
Does your child ever share activities that he/she enjoys at school? What is
his/her favorite subject?
Did you feel he/she might have any language or cultural difficulties?
What interventions has the school implemented related to your child's IEP
to help your child improve in any areas in which he/she may struggle?
Did you feel those interventions were effective? Why or why not?
Do you have any particular goals that you hope your child reaches during
this school year?
Any other additional information you can provide about your child that
would be helpful?

Teacher Interview- Use one form for each teacher you have the
opportunity to interview.
Student Name:
Teacher Name(s):
Location (Phone, Email, In-person):
Date and Time of Interview:
What do you feel are this students greatest strengths in school?
Are there any areas you feel this child struggles with in school? Any
particular subjects? During certain types of activities?
Do you have any insight into particular activities or content areas that the
student really enjoys?
Did you feel he/she might have any language or cultural difficulties that
affect his/her success in school?
What interventions have you implemented related to this student's IEP to
help this student improve on any areas where he/she is eligible for special
education?
Did you feel those interventions were effective? Why or why not?
Any other additional information you can provide about this student that
would be helpful?